Abstract: SA-PO1020

Acute Myeloid Leukemia Presenting as Nephrotic Syndrome

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Author

  • Saeed, Maryam K, University of Illinois- Urbana Champaign, Urbana, Illinois, United States
Background

Nephrotic syndrome(NS) is characterized by heavy proteinuria,hypoalbuminemia and peripheral edema.Acute Myeloid Leukemia(AML) has been rarely reported in association with NS.

Methods

73 year old white male presented with lower extremity edema and dyspnea for the last 3 weeks.He denied chest pain,palpitations, fevers,or recent immobilization.History was significant for non-insulin dependent type II diabetes mellitus with neuropathy without retinopathy and hypertension.On examination his blood pressure was 160/80mm Hg with + 2 pitting peripheral edema.Basic labs showed hemoglobin of 12.7g/dL,Creatinine 0.8 mg/dL,total serum protein 6.8mg/dL,albumin 3.6g/dL with 24 hour urine protein of 5.9 grams and no hematuria.Echocardiogram and renal ultrasound were unremarkable.Furosemide was initiated for suspected diabetic nephropathy.However, patient’s edema significantly worsened with development of ascites.Repeat labs showed proteinuria(5.6g/24 hours)and hypoalbuminemia(2.9g/dL).Serum complement levels,hepatitis panel,antinuclear antibody levels were unremarkable.A renal biopsy was scheduled for possible secondary causes of NS.Labs prior to biopsy showed a decreased white cell count of 3.1 x10^3/uL,hemoglobin of 8.9 g/dl,MCV of 67.6 fL and normal platelet count.Peripheral smear revealed neutropenia with left shift and frequent blasts.The patient was referred for urgent bone marrow biopsy and flow cytometry with results consistent with AML.Azacitadine chemotherapy was subsequently started.Renal biopsy revealed features consistent with renal involvement by extramedullary myeloid neoplasm,diffuse glomerular mesangial sclerosis and changes suggestive of chronic thrombotic microangiopathy.
Despite chemotherapy,the patient’s condition worsened with development of healthcare associated pneumonia,refractory ascites and multiple hospital readmissions.Eventually the patient decided to opt for comfort care measures

Conclusion

Hematological malignancies associated with NS are mainly Hodgkin's and non-Hodgkin's lymphomas and chronic lymphocytic leukemia.The onset of NS in patients with AML is reported after development of leukemia,during chemotherapy or at presentation.In our patient NS preceded AML with evidence of renal extramedullary hematopoiesis, rarely described with myeloproliferative neoplasms.